Fibroids Flashcards
Fibroids medical Mx
Conservative if asymptomatic
Treatments for HMB
Injectable GnRH agonist
Ulipristil acetate
Treatments for HMB
LNG-IUS (1st line)
Tranexamic acid
Mefenamic acid
COCP
Which fibroid unaffected by HMB treatments?
Submucal fibroid or enlarged uterus palpable abdominally
Injectable GnRH agonists ib fibroids?
Only widely proven effective medical Rx
Induces menopausal state shuts down ovarian oestradiol
poorly tolerated
Ulirpristil acetate in fibroids
SPRM
reduces size and HMB Sx
Not yet widely used
Does NOT induce menopausal state
Medical Mx of fibroids, is it possible?
Not long term
Fibroids regrow when ovarian function returns
Surgical Mx of fibroids
Depends on Sx
- Minimally invasive hysteroscopic
- Myomectomy
- Surgical removal w/uterine conservation
- Hysterectomy
Suitable fibroids for minimally invasive hysteroscopic sugery
Submucosal
Fibroid polyp
Which surgical procedures are indicated in bulky Fibroid uterus w/pressure Sx ?
(Or refractory to medical Rx)
- (laparoscopic)Myomectomy:
- preservation of fertility
- small but sig. risk of uncontrolled bleed -> hysterectomy - Surgical removal of fibroids w/uterine convervation
- Hysterectomy
Which procedures for fibroid removal may be preceded with GnRH agonist? Why?
Hysterectomy and myomectomy
3mo
reduce bulk and vascularity of fibroid (allows suprapubic vaginal incision rather than midline TAH)
Quicker recovery, fewer Cx
Radiological Treatmeant of Fibroids?
Uterine Artery Embolisation
Uterine Artery embolisation procedure
Embolise both UAs under radio guidance
Cannula: femoral -> UA
Embolisation induces infarction and degeneration
% of Uterine artery embolisation procedures that reduce fibroid volume?
50%
Aftercare in Uterine artery embolisation
Often req. admission for pain, give opiate analgesia
Complications of uterine artery embolisation
Fever Infection Fibroid expulsion Potential ovarian failure Treatment failure (1/3 req. some treatment within 5y)